A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study
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JMIR FORMATIVE RESEARCH Okpara et al
Original Paper
A Patient-Initiated Digital COVID-19 Contact Notification Tool
(TellYourContacts): Evaluation Study
Kelechi S Okpara1,2, PharmD; Jennifer Hecht3,4, MPH; Dan Wohlfeiler3, MJ, MPH; Matthew Prior5, MPH; Jeffrey D
Klausner6, MD, MPH
1
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
2
Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
3
Building Healthy Online Communities, San Francisco, CA, United States
4
San Francisco AIDS Foundation, San Francisco, CA, United States
5
National Coalition of STD Directors, Washington, DC, United States
6
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
Corresponding Author:
Kelechi S Okpara, PharmD
David Geffen School of Medicine
University of California, Los Angeles
10833 Le Conte Ave
Los Angeles, CA
United States
Phone: 1 (310) 825 6373
Email: kokpara@mednet.ucla.edu
Abstract
Background: Contact notification is a method used to control the spread of infectious disease. In this process, a patient who
tests positive for an infectious disease and public health officials work to identify the patient’s close contacts, notify them of their
risk of possible exposure to the disease, and provide resources to facilitate the decreased spreading of disease. Contact notification
can be done physically in person, via phone call, or digitally through the use of media such as SMS text messages and email.
When alerts are made through the latter, it is called digital contact notification.
Objective: For this study, we aim to perform a preliminary evaluation of the use of the TellYourContacts website, a digital
contact notification tool for COVID-19 that can be used confidentially and anonymously. We will gather information about the
number of website users and message senders, the types of messages sent, and the geographic distribution of senders.
Methods: Patients who chose to get tested for COVID-19 and subsequently tested positive for the disease were alerted of their
positive results through Curative Inc (a COVID-19 testing laboratory) and Healthvana (a results disclosure app). Included in the
notification was a link to the TellYourContacts website and a message encouraging the person who tested positive for COVID-19
to use the website to alert their close contacts of exposure risk. Over the course of three months, from May 18, 2020, to August
17, 2020, we used Google Analytics and Microsoft Excel to record data on the number of website users and message senders,
types of messages sent, and geographic distribution of the senders.
Results: Over the course of three months, 9130 users accessed the website and 1474 unique senders sent a total of 1957 messages,
which included 1820 (93%) SMS text messages and 137 (7%) emails. Users sent messages from 40 US states, with the majority
of US senders residing in California (49%).
Conclusions: We set out to determine if individuals who test positive for COVID-19 will use the TellYourContacts website to
notify their close contacts of COVID-19 exposure risk. Our findings reveal that, during the observation period, each unique sender
sent an average of 1.33 messages. The TellYourContacts website offers an additional method that individuals can and will use
to notify their close contacts about a recent COVID-19 diagnosis.
(JMIR Form Res 2021;5(3):e23843) doi: 10.2196/23843
KEYWORDS
patient-led digital contact notification; COVID-19; digital contact tracing; contact notification website
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JMIR FORMATIVE RESEARCH Okpara et al
postcards to their partners, investigators of the project found
Introduction that
JMIR FORMATIVE RESEARCH Okpara et al
Figure 1. Curative Inc email sent to those with a positive COVID-19 test result, with a "notify" link to the TellYourContacts website (Florida).
Healthvana, a results disclosure app, delivers COVID-19 test up to 10 close contacts at a time. Additionally, they have the
results to patients located in California. Within the positive option to send their message(s) anonymously or confidentially,
result message, Healthvana sends patients with COVID-19 the where the user has the option to enter their name. Users also
TellYourContacts website link [19] (Figure 2). have the option to create their own custom message or to send
a prewritten message. The TellYourContacts message alerts the
In addition, the TellYourContacts website was also advertised
recipient that they may have been exposed to COVID-19 and
to members of CDC-funded STD organizations as well as
it is recommended for them to isolate at home as well as seek
through a press release, social media, and word of mouth.
testing. They are also directed to the CDC’s coronavirus
Once on the TellYourContacts website, users have the option information webpage (Figures 3 and 4).
to either send their notification(s) via email or text message to
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Figure 2. Healthvana message sent to those with a positive COVID-19 test result, with a link to the TellYourContacts website.
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Figure 3. The TellYourContacts website offers prewritten and custom messages for users to send via SMS text message.
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Figure 4. The TellYourContacts website offers prewritten and custom messages for users to send via email.
Lastly, the website provides information about which contacts Data Protection Regulation–compliant email service provider
should be notified and provides direct links to the CDC website certification [22-24].
for users to learn more about COVID-19 [15,20].
Data Collection and Analysis
To maintain confidentiality and privacy, TellYourContacts does We collected data about the total number of emails and messages
not record the user’s contact information unless voluntarily that were sent by both Curative Inc and Healthvana to notify
provided. As users access the website and input information patients of their positive COVID-19 results. From that, we
such as their contacts’ email addresses and phone numbers, their estimated the number of messages sent to patients observed in
connection and data are encrypted and secured via hypertext our study. Additionally, we collected data regarding
transfer protocol by the third-party service provider GoDaddy TellYourContacts website use including message senders, types
(GoDaddy Inc). The TellYourContacts website does not use of messages sent, and approximate geographic location of
cookies, though its third-party providers may. Additionally, the senders from Google Analytics. We input the data into Microsoft
website neither stores the email addresses or phone numbers of Excel software (version 16.16.12; Microsoft Corp) to sum the
the user’s contacts nor does it link information to an individual. total quantities of the aggregate website data and used
The website also uses services from Mailjet (Mailjet Inc), Twilio descriptive statistics to determine the mean number of messages
(Twilio Inc), and Google Analytics (Google) for email sent per unique user within the observation period.
transmission, SMS text message transmission, and collection
of aggregate data that includes the total number of users who Results
access the website, the total number and types of messages sent,
and the general location of users as determined by internet From May 18, 2020, to August 17, 2020, Healthvana reported
protocol (IP) address [21]. These providers have their own 125,652 positive COVID-19 test results to patients in California.
respective measures of security, which include ISO 27001 Additionally, from May 18, 2020, to August 17, 2020, Curative
Information Security Management compliance and General Inc notified 71,866 patients of their positive COVID-19 test
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results across the United States. During the observation period, accessed the TellYourContacts website (Figure 5).
from May 18, 2020, until August 17, 2020, a total of 9161 users
Figure 5. Number of TellYourContacts users per date, from May 18, 2020, to August 17, 2020.
Of these users, a total of 1957 sent messages. We found that Australia, and Morocco. Senders in the United States made up
users chose to send SMS text messages over emails in a 13:1 the majority of total senders (97%), representing 40 states.
ratio (1820 [93%] via SMS text messaging and 137 [7%] via Within the United States, California accounted for the majority
email). Messages were sent by users from the following 13 of senders (864/1754, 49%). Texas and Massachusetts accounted
countries: the United States, Canada, Dominican Republic, for the second-most senders, both with 113 (6%) each (Figure
Mexico, the United Kingdom, South Africa, Japan, Bulgaria, 6).
Puerto Rico, French Guiana, the United Arab Emirates, Sweden,
Figure 6. Number of TellYourContacts message senders by state, from May 18, 2020, to August 17, 2020.
three months, 9161 users accessed the website and 1474 unique
Discussion senders sent a total of 1957 messages notifying their close
We described the use of a newly created digital notification contacts of possible COVID-19 exposure risk; the messages
platform, TellYourContacts, and found that over the course of were sent from the majority of states in the United States. Our
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results demonstrate that individuals will use a digital notification 81% of Americans owned a smartphone, an increase of over
platform to notify their contacts. 20% compared to five years prior [26]. Geographically,
California accounted for the majority of the locations from
Currently, there are various modalities being used for digital
where messages were sent. This may be because most positive
COVID-19 contact notification globally, such as
cases observed in our study were tested in California.
smartphone-based contact tracing apps. These apps use either
Bluetooth, GPS, or quick response (QR) codes to inform This study is not without its limitations. First, our evaluation
individuals that they may have been exposed to a case. may have underestimated the number of people who may have
Bluetooth-based contact notification apps measure the signal received information about the TellYourContacts website
strength of nearby smartphones to determine the user’s because those who were tested at institutions such as nursing
proximity to and duration of an encounter with those infected. homes and homeless shelters were manually excluded from the
GPS-based contact notification apps geolocate users to total observed count. Second, the TellYourContacts website
determine their proximity to those infected. Lastly, QR-based has the potential to be misused, as messages can be sent for
contact notification apps use QR barcodes that are scanned upon unintended purposes. IP addresses are collected by Google
one’s entrance to public spaces to monitor the user’s visited Analytics, a third-party provider, to geolocate and provide
locations [3]. In contrast to other forms of COVID-19 contact relevant COVID-19–related information by region. Currently,
notification, such as the Apple and Google Exposure an anti–IP address spoofing mechanism is in use to filter out
Notification System that uses Bluetooth to automatically notify false IP addresses associated with bots. Lastly, due to the nature
close contacts that have opted in, TellYourContacts assists users and privacy policies of the website, data regarding the
in the process of contact notification while maintaining user demographic characteristics of each person tested for
agency [25]. It gives users the ability to control how they send COVID-19, the percentage of those who sent anonymous
their messages by providing them with the option to personalize messages, and amount of contacts who read the message and
their message or use preformed messages and anonymize took precautions such as isolation, symptom self-checking, and
themselves. This tool can be especially helpful for users who testing, cannot be obtained and analyzed.
might not feel comfortable directly telling their contacts or who
With innovations in technology, 90% of Americans use the
might not know how to directly tell their contacts about their
internet and 81% own a smartphone [26,27]. As a result, digital
exposure risk, all while providing their contacts with website
means such as emailing and text messaging are increasingly
links to COVID-19 educational resources. Additionally,
used to communicate. TellYourContacts gives individuals who
TellYourContacts can be used without the need to download
are positive for COVID-19 the ability to initiate contact
and install an app—which would require authorizing additional
notification with tools they already use, such as smartphones
permissions and continuous updates—on a phone or other
and computers. After the evaluation of the TellYourContacts
electronic device.
website, we found supportive evidence that TellYourContacts
Users of TellYourContacts chose to send the majority of is a viable, low-threshold method that people will use to aid in
messages to their close contacts via text message. This result contact notification for COVID-19. Continued social marketing
might possibly be due to the convenience and increasing research is needed to further increase its use.
popularity of text messaging over the past two decades. In 2019,
Acknowledgments
The authors wish to thank Isaac Turner of Curative, Inc., Ramin Bastani of Healthvana, Gene Peterson of Bitrageous, LLC, Erin
Fratto of National Coalition of STD Directors (NCSD), and Annabel Mangold of Mangold Design for their work and assistance
with TellYourContacts. Funding for TellYourContacts.org was provided by Team Klausner Saving Lives (TKSL), Building
Healthy Online Communities (BHOC), and NCSD.
Conflicts of Interest
None declared.
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Abbreviations
BHOC: Building Healthy Online Communities
CDC: Centers for Disease Control and Prevention
IP: internet protocol
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NCSD: National Coalition of STD Directors
QR: quick response
STD: sexually transmitted disease
TKSL: Team Klausner Saving Lives
Edited by G Fagherazzi; submitted 25.08.20; peer-reviewed by B Suffoletto, B Bente; comments to author 09.12.20; revised version
received 29.01.21; accepted 10.02.21; published 05.03.21
Please cite as:
Okpara KS, Hecht J, Wohlfeiler D, Prior M, Klausner JD
A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study
JMIR Form Res 2021;5(3):e23843
URL: https://formative.jmir.org/2021/3/e23843
doi: 10.2196/23843
PMID: 33621189
©Kelechi S Okpara, Jennifer Hecht, Dan Wohlfeiler, Matthew Prior, Jeffrey D Klausner. Originally published in JMIR Formative
Research (http://formative.jmir.org), 05.03.2021. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The
complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and
license information must be included.
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